ESTELA AZEKA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
27 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 27
- PEDIATRIC HEART TRANSPLANTATION PROGRAM: SINGLE CENTER EXPERIENCE OF 20 YEARS(2013) AZEKA, Estela; GALAS, Filomena; TANAMATI, Carla; PENHA, Juliano; FERNANDES, Marcos; SENAHA, Luciano; XAVIER, Johnny; DELGADO, Ana Beatriz Romani; KAJITA, Luiz; AIELLO, Vera; BENVENUTI, Luiz; MIURA, Nana; AULER JUNIOR, Jose Otavio Costa; JATENE, MarceloOBJECTIVE: Heart transplantation has been the treatment of choice for children with refractory to conventional therapy. To report the experience with heart transplantation in a single center. MATERIAL AND METHODS: To report the single center experience of hearttransplantation. Data analysis was demographic characteristics, clinical outcome and survival Kaplan Meier curve. RESULTS: From October 30, 1992 to October 2nd, 2012, 120 transplants were performed and 115 patients were submitted to heart transplantation at Heart Institute (InCor) University of Sao Paulo Medical School, Sao Paulo, Brazil. The causes of indication for transplantation were: cardiomyopathies (76%) and congenital heart disease (24%). Five patients were submitted to re-transplantation. Three of them were re-transplanted on the early postoperative period with high mortality (66.6%). One patient was submitted to simultaneous re-transplantation and kidney transplantation after 13.9 yrs of follow-up and one of patient was successful re-transplanted after 10 yr of follow-up. The post-operative immunosuppression regimen was double immunosuppression and polyclonal anti-thymocyte serum induction therapy. The actuarial survival was 80%, 71%, and 61% at 1, 5, and 10 yr, respectively. CONCLUSION: Heart transplantation has been a promising option for children. The use of double immunosuppression with polyclonal anti-thymocyte serum induction therapy combined with surveillance of acute rejection with non-invasive tests may provide favorable clinical outcome.
- The Fontan immunophenotype and post-transplant outcomes in children: A multi-institutional study(2023) MANTELL, Benjamin S.; AZEKA, Estela; CANTOR, Ryan S.; CARLO, Waldemar F.; CHRISANT, Maryanne; DYKES, John C.; HOFFMAN, Timothy M.; KIRKLIN, James K.; KOEHL, Devin; L'ECUYER, Thomas J.; MCALLISTER, Jennie M.; PRADA-RUIZ, Adriana C.; RICHMOND, Marc E.BackgroundPatients after Fontan palliation represent a growing pediatric population requiring heart transplant (HTx) and often have lymphopenia (L) and/or hypogammaglobinemia that may be exacerbated by protein-losing enteropathy (PLE, P). The post-HTx effects of this altered immune phenotype are not well studied. MethodsIn this study of the Pediatric Heart Transplant Society Registry, 106 Fontan patients who underwent HTx between 2005 and 2018 were analyzed. The impact of lymphopenia and PLE on graft survival, infection, rejection, and malignancy was analyzed at 1 and 5 years post-HTx. ResultsThe following combinations of lymphopenia and PLE were noted: +L+P, n = 37; +L-P, n = 23; -L+P, n = 10; and -L-P, n = 36. Graft survival between the groups was similar within the first year after transplant (+L+P: 86%, +L-P: 86%, -L+P: 87%, -L-P: 89%, p = .9). Freedom from first infection post-HTx was greatest among -L-P patients compared to patients with either PLE, lymphopenia, or both; with a 22.1% infection incidence in the -L-P group and 41.4% in all others. These patients had a significantly lower infection rate in the first year after HTx (+L+P: 1.03, +L-P: 1, -L+P: 1.3, -L-P: 0.3 infections/year, p < .001) and were similar to a non-single ventricle CHD control group (0.4 infections/year). Neither freedom from rejection nor freedom from malignancy 1 and 5 years post-HTx, differed among the groups. ConclusionsFontan patients with altered immunophenotype, with lymphopenia and/or PLE, are at increased risk of infection post-HTx, although have similar early survival and freedom from rejection and malignancy. These data may encourage alternative immunosuppression strategies and enhanced monitoring for this growing subset of patients.
- Clinical approach to mechanical circulatory support in the transplant patient from the Pediatric Heart Transplant Society(2022) BEARL, David W.; JEEWA, Aamir; AUERBACH, Scott R.; AZEKA, Estela; PHELPS, Christina; SACKS, Loren D.; ROSENTHAL, David; CONWAY, JenniferThe use of mechanical circulatory support (MCS) for pediatric patients who have undergone heart transplant has grown rapidly in the past decade. This includes support in the immediate post-transplant period and ""rescue"" therapy for patient later in their transplant course. Extracorporeal membrane oxygenation (ECMO) remains a standard modality of support for intraoperative concerns and for acute decompensation in the immediate post-transplant period. However, both pulsatile and continuous flow ventricular assist devices (VADs) have been used with increasing success in transplant patients for longer durations of support. Centers participating in the Pediatric Heart Transplant Society (PHTS) were queried to provide their internal protocols and rationale for mechanical circulatory support following heart transplant. These protocols coupled with evidence-based literature were used to provide the following description of clinical approaches to MCS in the transplant patient highlighting areas of both broad consensus and significant practice variation.
- Clinical approach to antibody-mediated rejection from the pediatric heart transplant society(2022) AMDANI, Shahnawaz; HENDERSON, Heather; EVERITT, Melanie D.; BEASLEY, Gary; SHIH, Renata; EXIL, Vernat; ALEJOS, Juan; WALLIS, Gonzalo; AZEKA, Estela; NANDI, Deipanjan; PROFITA, Elizabeth; SPINNER, Joseph; MAGNETTA, Defne; MARTINEZ, Hugo; FENTON, Matthew; CONWAY, Jennifer; URSCHEL, SimonObjective This document is designed to outline the definition, pathogenesis, diagnostic modalities and therapeutic measures to treat antibody-mediated rejection in children postheart transplant Methods Literature review was conducted by a Pediatric Heart Transplant Society (PHTS) working group to identify existing pediatric and adult studies on antibody-mediated rejection (AMR). In addition, the centers participating in PHTS were asked to submit their approach to diagnosis and management of pediatric AMR. This document synthesizes information gathered from both these sources to highlight a practical approach to diagnosing and managing a child with AMR postheart transplant. This document may not represent the practice at all centers in the PHTS and serves as a starting point to understand an approach to this clinical scenario.
conferenceObject HEART TRANSPLANTATION IN PEDIATRIC AND ADULT WITH CONGENITAL HEART DISEASE: CURRENT STATUS.(2017) COUTINHO, K.; SIQUEIRA, A.; BENVENUTI, L.; MIURA, N.; JATENE, M.; AZEKA, E.- NEUROLOGICAL COMPLICATIONS AFTER PEDIATRIC HEART TRANSPLANTATION(2013) FERNANDES, Marcos; AZEKA, Estela; SENAHA, Luciano; DELGADO, Ana Beatriz Romani; GALAS, Filomena; GUIMARAES, Vanessa; HAJJAR, Ludmilha; TANAMATI, Carla; PENHA, Juliano; AULER JUNIOR, Jose Otavio Costa; JATENE, MarceloOBJECTIVES: Neurological complications can occur after pediatric heart transplantation and its outcome may cause disabilities and limit the prognosis of children who have undergone this procedure. The aim of the study is to evaluate the neurological complications during the first 30 days after the heart transplantation. MATERIAL AND METHODS: A survey was made at based on the InCor records to find the data. RESULTS: From September 2011 to September 2012, 15 heart transplants were performed at the Heart Institute (InCor) University of Sao Paulo Medical School. The mean age was 11.1± yr5.34 yrs, median 9.63 yrs. There were 8 (53.3%) males. The diagnosis for heart transplantation was 80% cardiomiopathies. Two of them wereë. re-transplantation. One patient was with ECMO before transplantation and one was with assist device. Seven of them were priority when listed for the heart transplantation. The immunosuppression therapy was calcineurin inhibitor and cytostatic drug. Induction therapy was performed with antithymocyte globulin. Eight (53%) of 15 patients developed neurological complications. The main cause were strokes in 37.5%. The other causes were anisocoria in 1 (12%) patient, ischemic vascular accident 1 (12%) patient, hemorrhagic vascular accident 1 (12%). Three (20%) of them died due to multiple organ failure and infection, two of them were in priority before transplant (one with assist device) and were intubated with renal failure and sedated. These two patients were the ones that showed the worse neurological complications after the transplant. CONCLUSION: Neurological complications were common after heart transplantation, patient can have favorable clinical outcome after treatment.
conferenceObject RESTRICTIVE AND HYPERTROPHIC CARDIOMYOPATHIES AS INDICATION FOR HEART TRANSPLANTATION: CLINICAL OUTCOME IN A SINGLE CENTER(2013) TANAKA, Ana Cristina; MIURA, Nana; THOMAZ, Ana Maria; AIELLO, Vera Demarchi; BENEVENUTI, Luiz; TAVARES, Glaucia; NOMURA, Cesar; JATENE, Marcelo Biscegli; AZEKA, EstelaPURPOSE: The purpose of this study was evaluate the prevalence and outcome of restrictive and hypertrophic cardiomyopathies in a cohort of pediatric heart transplantation. METHOD: To evaluate the prevalence and clinical outcome of children with restrictive and hypertrophic cardiomyopathies submitted heart transplantation. RESULTS: From october 1992 to 2012, 115 patients were submitted heart transplantation. 120 transplants were performed at Heart Institute (InCor) University São Paulo Medical School. Seventeen (14,7%) of these patients hat restrictive cardiomyopathy/hypertrophic cardiomyopathy and have undergone to heart transplantation. The mean age was 10,4 years. Survival was 76,4%. Follow-up period ranged from 26 days to 6,6 years. CONCLUSION: Restrictive and hypertrophic cardiomyopathies can be an indication for heart transplantation a favorable outcome.- POSTTRANSPLANT LYMPHOPROLIFERATIVE DISEASE IN CHILDREN AFTER HEART TRANSPLANTATION(2013) MARCONDES, Rafael; JATENE, Marcelo; CRISTOFANI, Lilian; TANAMATI, Carla; FERNANDES, Marcos; BENVENUTI, Luiz; ODONI, Vicente; MIURA, Nana; AZEKA, EstelaOBJECTIVE: The purpose of this study was to evaluate the prevalence of PTLD after pediatric heart transplantation in a single center. PATIENTS AND METHODS: From 1992 to 2012, 115 patients were submitted to heart transplantation. One hundred and twenty transplants were performed. The clinical findings and outcome were evaluated. RESULTS: Nine (7.8%) of 115 patients developed PTLD. The presentation of PTLD was cervical tumor in three patients, abdominal tumor in three patients and pulmonary nodules in three patients. Five (55.5%) patients are alive. All had positive serology for EBV. CONCLUSION: PTLD is a severe complication after heart transplantation. Therapeutic strategies need to be developed to improve the survival in this
conferenceObject CLINICAL CHALLENGES AFTER PEDIATRIC HEART TRANSPLANTATION: 20 YEARS OF EXPERIENCE(2013) AZEKA, Estela; AULER, Jose Otavio; GALAS, Filomena; TANAMATI, Carla; PENHA, Juliano; KAJITA, Luiz; AIELLO, Vera; BENVENUTI, Luiz; JATENE, MarceloPURPOSE: Heart transplantation has been the treatment of choice for children with refractory to conventional therapy. Objective: to report the clinical experience with heart transplantation in a single center. METHOD: To report the single center experience of heart transplantation. Data analysis was demographic characteristics, clinical outcome and survival Kaplan Meier curve. RESULTS: From October 30, 1992 to October 2nd, 2012, 120 transplants were performed and 115 patients were submitted to heart transplantation at Heart Institute (InCor) University of Sao Paulo Medical School, Sao Paulo, Brazil. The causes of indication for transplantation were: cardiomyopathies (76%) and congenital heart disease (24%). Five patients were submitted to re-transplantation. Three of them were re-transplanted on the early postoperative period with high mortality (66.6%). One patient was submitted to simultaneous re-transplantation and kidney transplantation after 13.9 years of follow-up and one of patient was successful re-transplanted after 10 year of follow-up. The post-operative immunosuppression regimen was double immunosuppression and polyclonal anti-thymocyte serum induction therapy. The actuarial survival was 80%, 71%, and 61% at 1, 5, and 10 yr, respectively. CONCLUSION: Heart transplantation has been a promising option for children. The use of double immunosuppression with polyclonal anti-thymocyte serum induction therapy combined with surveillance of acute rejection with non-invasive tests may provide favorable clinical outcome.- Desmoid tumour of the chest wall in paediatric post-operatory of heart transplant(2022) FILHO, Orival de Freitas; NAKAHIRA, Evelyn Sue; SCHMIDT JUNIOR, Aurelino Fernandes; AZEKA, Estela; JATENE, Marcelo Biscegli; PEGO-FERNARDES, Paulo ManuelWe will report a case of a desmoid tumour (DT), which developed at the surgical site of the pacemaker after a late childhood heart transplant. Patients with idiopathic dilated cardiomyopathy followed up in the paediatric cardiology service. It evolved with the dissociation of ventricular rhythm caused by severe heart failure, which led to the implantation of a cardiac resynchronization device prior to heart transplantation. The progression to end-stage heart disease culminated in a heart transplant at 12 years old. One year after the transplant, at the age of 13 years, he presented a progressively growing mass on the generator site of the resynchronization device. The initial decision was to remove the device. During the removal surgery, there was no haematoma or fluid collection. However, there was a progression of the lesion. The lesion was biopsied with the anatomopathological diagnosis of a DT. Resection surgery happened 4 months after the start of the mass growth. At that time, the tumour reached 20 cm in diameter. The lesion infiltrated the pectoralis major muscle and this muscle was resected partially en bloc with the lesion. The defect had primary closure. The patient evolved without postoperative complications and was discharged on the 14th postoperative day. The surgical specimen came with negative circumferential margins. However, the deep margin was microscopically positive. Due to deep involvement, the patient underwent adjuvant radiotherapy. Currently, the patient is under clinical follow-up and has no evidence of tumour recurrence. DT is a rare tumour, with unpredictable courses. Surgery can be considered in the progression of lesions. Treatment is justified by long survival after a heart transplant and in DT patients. DT is a differential diagnosis to be considered in progressive growth lesions.
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